Double Wall versus Single Wall Incubator for Reducing Heat Loss in Very Low Birth Weight Infants in Incubators

By Norton-Westwood, Deborah | International Journal of Child and Adolescent Health, January 1, 2011 | Go to article overview

Double Wall versus Single Wall Incubator for Reducing Heat Loss in Very Low Birth Weight Infants in Incubators


Norton-Westwood, Deborah, International Journal of Child and Adolescent Health


Introduction

The research question raised was to assess the effects of double wall incubator versus a single wall incubator on infant morbidity and mortality.

Relevance for Nursing

In order to survive, studies have shown that newborn infants must be able to maintain an age appropriate temperature range or ?thermoneutral state'. According to Blackburn,(1) this is where the gradient between skin and core temperature is the least resulting in minimal glucose and oxygen consumption thus providing an equilibrium between heat loss and heat gain. Premature infants' less than 37 weeks, are physiologically incapable of maintaining a thermoneutral state. In such cases, an artificial environment in the form of an incubator is required. Current technology of incubators allows for varying levels of humidity and ambient temperature to be adjusted in order to achieve a neutral thermal environment according to an infant's gestational age and weight. Such intervention allows the infant to minimise his/her metabolic rate and oxygen consumption thereby conserving vital energy stores required for optimum growth.

Study characteristics

There were no randomised controlled studies included in this review with only three (3) quasi-randomised cross over studies conducted in either 1980 and 1981 meeting inclusion requirements. Methodological quality of the studies was satisfactory. The reviewers concluded that the study methods were of good quality and demonstrated minimal evidence of bias. The studies compared double wall to single wall incubators in providing and maintaining a thermoneutral environment for newborn and premature infants, a total of 28 participants were included. Newborn and premature infants were defined as less than 37weeks or 2500gms and were either clothed or unclothed, with a postnatal age of 14 days or less. They were nursed in single or double wall incubators with or without humidity. Only short term outcomes including oxygen consumption, heat production and heat loss, physiologic parameters (heart and respiratory rate), and heat exchange data were reported in the studies. Primary outcomes of morbidity and mortality although desired were not reported.

Summary of key evidence

· Physiologic parameters : Two studies stated there was no significant difference in physiologic parameters (heart rate and respiratory rate) in the two environments.

· Oxygen consumption : Two of the three studies noted a decrease in oxygen consumption in infants nursed in double wall as compared to single wall incubators [Weighted Mean Difference [WMD] -0.59 (95% Confidence Interval [CI]-1.09, 0.09)] while the third study stated there was no difference in oxygen consumption in either environment.

· Heat production and heat loss : Two studies demonstrated a reduction in total heat production in double wall incubators, [WMD -0. …

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